Page 47 - Hoag Orthopedic Institute 2018 Outcomes Report

WHITE PAPER
Reverse Shoulder Arthroplasty –
A Reliable Treatment Option For Patients With Rotator Cuff Tears And Arthritis Dave R. Shukla, MD, Russell S. Petrie, MD, Scott P. Fischer, MD
Reverse shoulder arthroplasty has emerged as a versatile treatment option for many indications. It was originally designed for patients without functional rotator cuffs who subsequently developed arthritis as a consequence of the malfunctioning joint. However, as medium-to- long term studies emerged that report reliable and sustained return of function and predictable pain relief, surgeons have recently expanded
its use to treat patients with severe shoulder fractures (acute or chronic), shoulder deformity, inflammatory arthritis (i.e. rheumatoid arthritis), and even arthritis with an intact but poorly functioning rotator cuff.
With age and overuse, the rotator cuff undergoes degeneration, and sometimes can completely rupture, particularly after a fall or trauma. Though the rotator cuff can often be repaired, there are instances in which it cannot be restored. Also,
in the setting of a rotator cuff tear with arthritis, repair is not recommended, as the patient will continue to have arthritic pain even if the cuff heals. Once the mechanical balance of the shoulder is disrupted, as in cases of an injured
or absent rotator cuff, joint degeneration can occur rapidly. While an ‘anatomic’ total shoulder replacement can be performed, studies have demonstrated that rotator cuff dysfunction will lead to early failure of this design. Alternatively, a ‘reversed’ ball and socket implant was designed to allow shoulder motion by relying on the deltoid muscle instead of the rotator cuff.
Figure 1. 2-Dimensional (left) and 3-Dimensional (right) coronal CT scan views of a patient with cuff-tear arthropathy and superior migration of the humeral head relative to the glenoid, with a clear disruption in ‘Shenton’s Line’ (dashed yellow line).
Figure 2. Specialized templating software allows for the
proper sizing and appropriate positioning of implant components pre-operatively.
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